Butler County has the highest number of cases of hepatitis-A of any county in Ohio ever since a statewide outbreak of the disease began in 2018.

The county has seen 279 cases of the disease since the beginning of 2018, according to Ohio Department of Health data that runs through Feb. 25 of this year. This accounts for more than 15 percent of  cases statewide.

Hepatitis-A is a communicable disease of the liver, and can be transmitted through fecal-oral contact or consumption of contaminated food or water. It causes inflammation and impacts the liver’s ability to function properly.

Symptoms of the disease may include fever, fatigue, nausea, vomiting, severe stomach pain, diarrhea, jaundice, dark urine and clay-colored bowel movements. The virus typically resolves within two months of infection, according to the Centers for Disease Control and Prevention.

This type of hepatitis differs from hepatitis-B and hepatitis-C, which primarily spread through contaminated bodily fluids. Hepatitis-A is less likely to become chronic, whereas B and C are more likely to.

Vaccinations Prevent the Virus

According to the Butler Co. Department of Health, anyone can get hepatitis-A, but some populations are more likely. High risk groups include illicit drug users, those incarcerated, the homeless, gay men, those having sexual contact with someone who has the disease and anyone who lives or works with someone who has it.

Fortunately, the virus can be prevented through vaccination. Hepatitis-A cases in the U.S. have declined dramatically, by almost 95 percent, since the invention of the vaccine in 1995. According to the CDC, children are advised to receive the vaccine between the ages of 12-23 months. Then they need a second dose six months after the last shot.

But, Butler County Health Commissioner Jennifer Bailer points out that this particular vaccine isn’t mandatory and a majority of the population in Butler County is not vaccinated for hepatitis-A. The county normally only sees a few cases of the virus per year. She said her department is striving to change the number of vaccinations during the current outbreak, particularly among high risk groups.

“We are vaccinating all the time,” Bailer said. “We did mass vaccinations in jails when the outbreak first started. We also have been to homeless centers and drug treatment centers.”

The commissioner said that more than 80 percent of cases in Butler County have come from these three particular high-risk groups: those in jail, the homeless and people in drug treatment centers.

“The evidence-based best practice for people in a high-risk group and those who live or work with them is to get vaccinated,” Bailer said. “This includes people providing care to high risk groups.”

At this time, Bailer said those who haven’t received the vaccine and don’t fall under one of the high-risk groups don’t necessarily need to obtain the shot. Healthy people are not the main groups being affected.

Outbreak May Have Peaked

Bailer says cases of hepatitis-A have dwindled recently in Butler County, but that doesn’t mean the outbreak is over. Last week, only one case of the disease was reported in the county.

“Our peak came in the fall and numbers have gone down significantly since,” Bailer said. “We are continuing with efforts, since it could pick up any time. We are not out of the woods.”

Other states have experienced recent outbreaks as well. Bailer says this may be the origin of Ohio’s outbreak.

“We don’t know how it really started,” Bailer said. “Other states have struggled with outbreaks and people move around and it could have started that way.”

In addition to vaccination, the county health department is also combatting the outbreak through educational efforts about the virus, policy change requests and distributing information cards to restaurants and food service workers. The department inspects local restaurants and raises awareness about the virus during the inspections, especially about the necessity of employee hand-washing.  

The virus can range from a mild illness lasting a week to a severe illness spanning several months. Bailer noted that this outbreak has produced a high number of hospitalizations — 60 percent of cases have been taken to the hospital. There have also been several fatalities stemming from the disease. The CDC states that death from hepatitis-A is rare, but is more common in those with other liver conditions and in those older than 50.  

Best Practices

According to the CDC and the Butler County Department of Health, the following best practices are recommended in dealing with hepatitis-A:

• Make sure to get vaccinated if you fall into a high-risk group. Use vaccinefinder.org to find a location near you.
• Wash your hands regularly and especially after using the restroom or coming in contact with an infected person’s blood, stools and bodily fluids.
• If you experience one or more of the symptoms described above, contact your healthcare provider.

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